Empowering shared surgical decisions with technology...We are creating electronic consenting and shared decision making tools to help patients, doctors, & hospitals. Leading to a paperless

Empowering shared surgical

decisions with technology

Concentric HealthEdward St John

22nd May 2019

1

1

Content

2Inform your decision…

• Who are Concentric

• What is shared decision making

• What’s happening in reality

• Research data

• What we are building

We are creating electronic consenting and shared

decision making tools to help patients, doctors, &

hospitals.

Leading to a paperless process with reduced errors,

facilitating data-supported, shared decisions.

1

Concentric Health


Concentric Team

Dafydd Loughran

CEO & Co-Founder

Surgeon

AI Clinician (Predictive Analytics) @ Babylon

Clinical Lead (Shared Decision Making) @ Public Health Wales

NHS Clinical Entrepreneur Fellow

Edward St John

Chief Medical Officer & Co-Founder

FRCS, Breast & General Surgeon

PhD, Honorary Clinical Research Fellow, Imperial College

NHS Clinical Entrepreneur Fellow

Martyn Loughran Tech Lead

Experienced CTO – Pusher, MOJ

Senior Technologist at Idean

Prof Alf Collins Advisor

Shared Decision Making expert

Clinical Director, NHS England

Paul Sankey Advisor

Medical Negligence Solicitor

Partner, Enable Law

George Sheldrake UX Design

Nike, BBC, MOJ

Dovetail Lab Technical partner

Specialist in Healthtech & Blockchain

EMIS Health

Elwyn G et al. A three-talk model for shared decision making: multistage consultation process. BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4891

Shared Decision Making

2011. Coulter A, Collins A

Shared decision making is when

health professionals and

patients work together. This puts

people at the centre of decisions

about their own treatment and

care.

It's important that:

•Care or treatment options are

fully explored, along with their

risks and benefits

•Different choices available to

the patient are discussed

•A decision is reached

together with a health and

social care professional.

https://doi.org/10.1136/bmj.j4891

Decision = Performance + Reliability + Cost

Tech spec:Speed, Size, etc

RepairsHow long car will last

Money

Consumer reviewsExpert opinionReputation

Stats, Expert opinion,Consumer reviews

Bank account Financial responsibilities

Measure:

How do we decide?




Money

Prolongs lifeIncreases QOL

ComplicationsNeed for further treatment

Suffering: Recovery - time in pain, time in healthcareRisks

Published literature, Expert opinion, PROMs

HES data etc, Expert opinionPRCs

Consumer reviewsExpert opinionBrand


Bank account financial responsibilities

Individual choice External factorsPROMs

Measure:

Measure:

How do we decide?




Money

Prolongs lifeIncreases QOL

ComplicationsNeed for further treatment

Suffering: Recovery - time in pain, time in healthcareRisks

Published literature, Expert opinion, PROMs

HES data etc, Expert opinionPRCs

Consumer reviewsExpert opinionBrand


Bank account financial responsibilities

Individual choice External factorsPROMs

Measure:

Measure:

How do we decide?

Surgical Consent in 2019

The ProblemPaper, guesswork and paternalism


Handwritten process – Lost forms,

DHSC requirement for a paperless NHS by 2023

>10 million Operations / year

>£46m Consent specific.

The apprenticeship model leads to variation, errors, and medico-legal

costs.

Changes to law – Montgomery.

£600m / year Surgical Negligence Bill

20% - Unnecessary OperationsPaternalism leads to inappropriate operating (King’s Fund research)

Potential saving = £11.6bn / year.

The law now requires:“Reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.”

Evaluation of Hand-written Consent

Completion of hand-written surgical consent

forms is frequently suboptimal

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Domain Failure Rate

Patient details 13%

Procedure details 31%

Doctor sign-off 17%

Patient Sign-off 14%

Correct

MissingRisks

44% of consent forms missing risks

• 3 NHS trusts (Croydon, RSCH, Imperial)

• Pan-surgical specialties assessed for consent form entry

• N=551 hand-written consent forms

St John et al. DOI: 10.1016/j.surge.2015.11.004

RSCH Breast Data, N=61

Significant variation in documentation of risks

per procedure

St John et al. DOI: 10.1016/j.surge.2015.11.004

• 2 NHS trusts (Croydon & RSCH)

• N=147 hand-written consent forms

Proof of Concept – Electronic Consent

Domain:(Total = 254)

Handwritten (Total = 121)

OpInform(Total = 133)

P-ValueFisher’s exact test

Form demographics 24(20%) 5(4%) <0.0001

Surgeon sign off 26(21%) 3(2%) <0.0001Patient sign off 19(16%) 3(2%) <0.0001Errors in Procedure, Benefits & Risks 46(38%) 0(0%) <0.0001

Any form error 70(58%) 11(8%) <0.0001

Digital forms:

• Significantly less error rates than handwritten forms

• Tended to list a higher number of risks per form (median[range]),

Digital 13[5-24] vs handwritten 11[3-18].

@Imperial: Digital vs Paper Consent

@Imperial: Shared Decision Making

General Surgery – 70pts, 25 surgeons

Breast Surgery - 126pts, 11 surgeons

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Least Patient Disagreement GS Breast

My doctor made it clear that a decision needs to be made 5 4

My doctor helped me understand all the information 7 7

Greatest Patient Disagreement GS Breast

My doctor and I thoroughly weighed the different treatment options 26 29

My doctor and I selected a treatment option together 24 24

My doctor asked me which treatment option I prefer 26 23

Assessed using validated – SDM-Q9 tool

17 17Inform your decision…

Facilitate discussion between patients & health professionals.

Enable trusts to go paperless, improve record keeping.

Mobile and Desktop, eSignature

Electronic shared decision making platform

Ensure all the appropriate information is shared with patients.

Improves outcomes & reduces errors currently seen.

Data science used to analyse increasing volumes of decision-critical data

Comprehensive resource of information

Allow patients to digest information at their own pace.

Share patient priorities & questions with their health professionals.

Patient reported complications & outcomes

Bespoke patient companion

The Solution

The Solution - Process


Resource Content with 50 specialty advisors

600 procedures

Imperial PilotElectronic Consent Record

Imperial TestBaseIntegrated electronic

Consent

Shared Decision

making MVPWe are here

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Early Traction…

Best Process Innovation

LBS People’s Choice Winners

Scale UpAcross UK & Beyond

‘Big Data’personalisation &

behaviour change

Innovate UK Grant

Evidence BaseAcademic Validation*

* BMJ Journal of Medical Ethics & RCSEd The Surgeon

Innovate UK 350k Grant

Natwest support

Where We Are:

ConclusioneConsent & SDM


• Consent is currently variable, prone to errors and lacks a process to encourage shared decision making

• Decisions require data to be informed and appropriate

• Electronic consent reduces variability, decreases form errors and prevents unintentional omission of risks

• Feedback loop of PRCs & PROMs will enable treatment options to be weighed against each other.

• Concentric = Data driven consent and SDM platform

Thank You

Questions?

Concentric.Health

7

Concentric_Hlth

[email protected]

company/surgical-consentin

Documents

Empowering shared surgical decisions with technology...We are creating electronic consenting and shared decision making tools to help patients, doctors, & hospitals. Leading to a paperless